Infection Flashcards
Chalmydia:
when to test? (1)
management (1)
management in pregnancy (1)
2 weeks post exposure
doxycycline (7 day course) if first-line
if pregnant then azithromycin, erythromycin or amoxicillin
When to send urine culture in LRTI:
certain groups (3)
certain finding on dip (1)
age >65
pregnancy (all cases)
men (all cases)
haematuria (visible or non visible)
What UTI med to avoid in pregnancy?
trimethoprim
avoid Nitro FINAL TERM but okay at start
asymptomatic bacteriuria in pregnant women?
treat 7/7 nitrofurantoin (unless end term)
man and UTI; do you refer to urology?
‘Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI).’
when to treat UTI in catheterised
is symptomatic 7/7 + consider chaining catheter
acute pyelonephritis management
the BNF currently recommends a broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
Pneumococcal vaccine (only offered one off as it does not mutate as fast as influenza). Who is it offered to?
all >65 years AND those with:
- asplenia or splenic dysfunction
- chronic respiratory disease: COPD, bronchiectasis, cystic fibrosis, interstitial lung disease. Asthma is only included if ‘it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant’
- chronic heart disease: ischaemic heart disease if requiring medication or follow-up, heart failure, congenital heart disease. Controlled hypertension is not an indication for vaccination
- chronic kidney disease (at stages 4 and 5, nephrotic syndrome, kidney transplantation)
- chronic liver disease: including cirrhosis and chronic hepatitis
- diabetes mellitus if requiring medication
immunosuppression (either due to disease or treatment). This includes patients with any stage of HIV infection
- cochlear implants
- patients with cerebrospinal fluid leaks
Influenza vaccine who is it offered to?
The Department of Health recommends annual influenza vaccination for people older than 65 years and those with:
chronic respiratory disease (including asthmatics who use inhaled steroids)
chronic heart disease (heart failure, ischaemic heart disease, including hypertension if associated with cardiac complications)
chronic kidney disease (at stages 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation)
chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis
chronic neurological disease: (e.g. Stroke/TIAs)
diabetes mellitus (including diet controlled)
immunosuppression due to disease or treatment (e.g. HIV)
asplenia or splenic dysfunction
pregnant women
Other at risk individuals include:
health and social care staff directly involved in patient care (e.g. NHS staff)
those living in long-stay residential care homes
carers of the elderly or disabled person whose welfare may be at risk if the carer becomes ill (at the GP’s discretion)
When to avoid an LP?
signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12
important organism causing LRTI in cystic fibrosis patients
Pseudomonas aeruginosa
Pseudomonas aeruginosa: what does it cause?
what type of bacteria? (1)
Gram -ve rod
chest infections (especially in cystic fibrosis)
skin: burns, wound infections, ‘hot tub’ folliculitis
otitis externa (especially in diabetics who may develop malignant otitis externa)
urinary tract infections
produces both an endotoxin (causes fever and shock) and exotoxin A (inhibits protein synthesis by catalyzing ADP-ribosylation of elongation factor EF-2)
Meningitis management:
<3 months
3 months - 50 years
>50 years
Initial empirical therapy aged < 3 months –> IV cefotaxime + amoxicillin (or ampicillin)
Initial empirical therapy aged 3 months - 50 years –> IV cefotaxime (or ceftriaxone)
Initial empirical therapy aged > 50 years IV cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
Other causes menigitis management
meningococcal
pneumococal
haemopgilus influenza
listeria
Meningococcal meningitis IV benzylpenicillin or cefotaxime (or ceftriaxone)
Pneumococcal meningitis IV cefotaxime (or ceftriaxone)
Meningitis caused by Haemophilus influenzae IV cefotaxime (or ceftriaxone)
Meningitis caused by Listeria IV amoxicillin (or ampicillin) + gentamicin
management of meningitis contacts
Prophylaxis to ALL households and close contacts of patients affected with meningococcal meningitis.
Prophylaxis should also be offered to people who have been exposed to respiratory secretion, regardless of the closeness of contact. The risk to contacts is highest in the first 7 days but persists for at least 4 weeks.
CIPROFLOXACIN or RIFAMPICIN
meningococcal vaccination should be offered to close contacts when serotype results are available, including booster doses to those who had the vaccine in infancy
for pneumococcal meningitis, no prophylaxis is generally needed. There are however exceptions to this. If a cluster of cases of pneumococcal meningitis occurs the HPA have a protocol for offering close contacts antibiotic prophylaxis. Please see the link for more details
TB: latent disease
treatment options (2)
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
Risk factors developing ative TB from latent?
silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy
Latent TB: can it spread
NO
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Trichomonas vaginalis
presents v similar to BV but BV is white thin discharge with CLUE cells
Trichomonas vaginalis treatment?
oral metronidazole 5-7 days
Wet mount: BV vs trichomonas
BV= clue cells
Trichoomonas: motile trophozoites
Tic bite:
diagnosis? (2)
can be clinical if erythema migraines present
OR ELISA antibodies to Borrelia burgdoferi
Tic bite:
what to do?
pull it out
no need for further investigations if asymptomatic
Lyme disease:
treatment (1)
doxycycline in early disease
or amoxicillin if I pregnancy
Lyme disease:
Sx
erythema migrans
‘bulls-eye’ rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
systemic features
headache
lethargy
fever
arthralgia
A 78-year-old nursing home resident with a long term catheter presents to general practice with a positive urine culture. This reveals an E coli sensitive to amoxicillin, trimethoprim and nitrofurantoin. He is otherwise well and denies any dysuria.
no Abx needed
Genital wart:
treatment 1st line for multiple (1) and solitary (1)
2nd line (1)
1st LINE=
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
2nd LINE=
imiquimod is a topical cream
dapagliflozin, which is an SGLT-2 inhibitor, + perineum risk
nectrotizing fasciitis
Necrotising fasciitis on there perineum - also called…
Fourniers gangrene
Bacterial vaginosis in pregnancy management
oral metronidazole 5-7 days
Bacterial vaginosis management If asymptomatic
no treatment (unless undergoing termination)
BV treatment
oral metronidazole 5-7 days
HPV vaccination
All 12- and 13-year-olds (girls AND boys) x 1 DOSE ONLY
HIV exposure (e.g. needle tick):
when to start (1)
how long for? (1)
when to re-test? (1)
a combination of oral antiretrovirals (e.g. Tenofovir, emtricitabine, lopinavir and ritonavir) as soon as possible (i.e. Within 1-2 hours, but may be started up to 72 hours following exposure) for 4 weeks
serological testing at 12 weeks following completion of post-exposure prophylaxis
Infectious mononucleosis:
which virus?
triad of Sx? (3)
Other feautres?
EBV
The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients:
sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged
pyrexia
Other:
malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis
How long does infectious mononucleosis last?
test for it?
2-4 wekes
Monostop test
EBV: (infectious mononucleosis)
management?
rest + conservative
avoid contact sports for 4 weeks (reduce splenic rupture)
Allergy to metronidazole with BV?
clindamycin
Spinal abscess: what scan to do?
MRI whole spine (check for skip lesions)
Erythema chronicum migrans - what caused by?
LYME disease can be thought of like a wave spreading when you drop a pebble in a pond - erythema migrans
Tetanus: when to repeat?
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is
MRSA carrier: what to do?
where to treat? (2)
nose: mupirocin 2% in white soft paraffin, tds for 5 days
skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
Abx for MSRA (3)
vancomycin
teicoplanin
linezolid
Bacterial vaginosis - overgrowth of predominately of….
Gardnerella vaginalis
Live attenuated viruses (5)
Live attenuated vaccines
BCG
MMR
oral polio
yellow fever
oral typhoid
most common STI
chlamydia
Campylobacter: (most common bacterial cause of infectious diseases)
symptoms (3)
management (1)
prodrome: headache/ malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis
usually self-limiting
clarithromycin
complications:
Guillain-Barre syndrome may follow Campylobacter jejuni infections
reactive arthritis
septicaemia, endocarditis, arthritis
bloating, abdominal pain, and non-bloody diarrhoea and she has noticed her stools are floating in the toilet bowl. The patient’s symptoms continue for 9 weeks.
Giardia infection
Giardia: management
metronidazole
gastroenteritis is characterised by a short incubation period and severe vomiting
Staphylococcus aureus
gastroenteritis typically has an incubation period of 3-4 days and causes diarrhoea that usually becomes bloody, lasting up to a week.
e coli
causes shigellosis infection, which usually begins 1-2 days after infection and causes fever alongside diarrhoea which is sometimes bloody.
shigella
diarrhoea and fever; symptoms usually occur between 6 hours and 6 days after infection.
salmonela
treatment chlamydia
doxycycline
Target rash + pneumonia (+ bilateral consolidations)§
Mycoplasma is associated with erythema multiforme
fever, rash and patients with predisposing haematological conditions, pancytopenia
parvovirus
is a tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
Chancroid
Methotrexate:
which drugs to avoid concurrently (2)
co-trimoxazole and trimethoprim
all anti-folate (–> bone marrow suppression)
A 22-year-old man presents with fatigue and a persistently sore throat for the past two weeks. On examination his temperature is 37.8ºC, pulse 78/min, there is widespread cervical lymphadenopathy and evidence of palatal petechiae. Given the likely diagnosis, which one of the following complications is he at risk from?
EBG - glandular fever
–> risk spenlic rupture
Subacute sclerosing panencephalitis
measles
prophylaxis for contacts of patients with meningococcal meningitis
Oral ciprofloxacin or rifampicin
Toxoplasmosis treatment
none if immunocompetent
(presents like the flu)
Taxoplasmosis
investigations (1)
CT findings? (1)
management if immunocompromised (1)
Serology
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen
management: pyrimethamine plus sulphadiazine for at least 6 weeks
Campylobacter jejune:
treatment
clarithromycin if severe
–> GB Syndrome !
Cipro is pronounced Sipro. For shigella and salmonella only
Cipro vs clarithromycin treatments for..
they both have hard ‘c’s that sound like k: Kampylobacter Klarithromycin
cipro is for soft ‘c’s like shigella/salmonella
Animal bites:
how to manage (1)
treatment (1)
most common cause (2)
don’t suture if possible
co-amox (doxy+met if allergic)
Most common animal: pasterella multoida, for humans: Streptococci
Conditions associated with EBV
Malignancies associated with EBV infection
Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas
The non-malignant condition hairy leukoplakia is also associated with EBV infection.
uncomplicated CAP Abx
amoxicillin
acute prostatitis
quinolone (ciprofloxacin) or trimethoprim
How to diagnose Hepatitis C
HCV RNA
whilst patients will eventually develop anti-HCV antibodies it should be remembered that patients who spontaneously clear the virus will continue to have anti-HCV antibodies
painless ulcer at site of sexual contact
chancre (Syphilis!)
Erysipelas: difference from cellulitis (1)
infection type (1)
more superficial than cellulitis
Streptococcus pyogenes (beta-hatmolytic group A)
Live attenuated vaccines
Live attenuated vaccines MI BOOTY:
Measles, mumps, rubella (MMR)
Influenza (intranasal)
BCG
Oral rotavirus
Oral polio
Typhoid
Yellow fever
You Musn’t Prescribe BCG Incase They Suddenly RIP
- Yellow fever (NB high levels of egg, so CI in egg allergic. Yellow like a yolk)
What is the best way to assess his response to treatment for hepatitis C triple therapy?
viral load - HCV RNA
Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel →
giardiasis
Abx Mastitis during breast-feeding
flucloxacillin
dental abscess ABx
amoxicillin
Bacillus cereus is typical of..
rice reheated
Syphillis management
intramuscular benzathine penicillin is the first-line management
longest incubation period of gastroenteritis
Giardaa (up to 6 weeks)
Behcets disease
oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen
(vasculitis)
Difference Giardia vs E coli
Giardia longer incubation tme (~4 days) and bloating
E coli 24-72hr
PID Abx
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
Treatment:
gonorrhoea (1)
chlamydia (1)
IM cefriazone
doxycycline or azithromycin
single painful ulcer genital - cause
chancroid = painful = H ducreyi
pneumonia after influenza infection - common bacteria
Staphylococcus aureus
Klebsiella pneumoniae is classically in
alcoholics
Test for leigonella
urine test
Pneumonia: flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Legionella
Leigonella management
Macrolides such as clarithromycin
Herpes in pregnancy
oral acyclovir until delivery by CS
Which anti-malaria –> psychotic Sx
MEfloquine = MEntal health
taken WEEKLY
anti-malaria –> photosensitivity
doxycycline
HIV diagnosis and screening
Combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV
which age groups do not get the BCG vaccine?
The BCG vaccine is not given to anyone over the age of 35, as there is no evidence that it works for people of this age group.
most common cause of UTI
E coli
(also most common cause of prostatitis)
back pain
monoclonal protein on serum electrophoresis
osteolytic lesions
renal disease
multiple myeloma
blood test to diagnose haemophilia
APTT
(if prolonged order factor VIII and IX assay)
notifiable diseases
food poisioning
mumps
meningitis
hepatitis A/ B / C
whooping coug
rabies
rocker bottom feet
WILLIAMS
X-linked dominant disorders
Fragile X !!!
and Rett
Alports
HIV and life insuracne
if test positive you have to declare it in future medical questionnaires and it may impact life insurance
most common cause of bacterial meningitis in adults
Strep pneumonia
most common cause bacterial meningitis in noenates
Streptococcau agalactiae
E coli
Strep pneumonia
40 year old - chance of having baby with Downs syndrome
1 in 100
(1%)
25 M holiday in thailand
swimming in lakes
muscle + joint pains
papular rash on body
schistosomiasis
HIV and chronic diarrhoea- most common organism
Cryptosporidiosis
antiphopshophlipid is associated with which skin problem
The correct answer is Livedo reticularis, which is a reticular, mottled, purplish discolouration of the skin that occurs due to impaired blood flow in the cutaneous vessels. In antiphospholipid syndrome (APS), the presence of antiphospholipid antibodies leads to a hypercoagulable state, causing thrombosis in small blood vessels. This vascular compromise manifests as livedo reticularis, particularly on the legs, arms, and trunk. The pattern is often described as resembling a fishnet or lace-like appearance and may become more prominent with cold exposure. Livedo reticularis is considered one of the characteristic cutaneous manifestations of APS and can be an early clinical sign of the syndrome.
Common cause of meningoencephalitis in HIV
LP= organism which stains positive with India Ink dye
Cryptococcosis
Viral warts causative organism family
Papovavirus (AKA Human Papillomavirus)
what type of virus family is influenza
Orthomyxovirus
